Incision techniques and flap designs for apical surgery in the anterior maxilla

Apical surgery is often a last resort, and is used to surgically preserve a tooth with a recurrent lesion of endodontic origin when conventional re-treatment is neither indicated nor clinically or financially feasible. Incision type and flap design are important factors to consider when outlining the surgical area: the first must ensure optimal access to the root end and the second must allow visibility. A variety of factors must be considered when choosing a specific incision technique, particularly in the anterior maxilla. These include status of the marginal periodontium, location and extent of the periapical lesion, presence of a restoration margin, and the patient's esthetic demands. The outcome with respect to soft tissue healing following apical surgery will further depend on anatomical and surgical aspects, such as the biotype of the gingiva, maintenance of vascular supply, marginal bone structure, technique of flap elevation and retraction, duration of surgery, and wound closure. It is important to address soft tissue healing with the patient during planning of apical surgery because, in solving the endodontic problem, a gingival recession may have been created.